MEDICARE: BRIDGEWAY HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1629932702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEWAY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3511 ETON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-6800
Country	:	US
Telephone Number	:	301-442-8846
Fax Number	:	301-442-8846

Provider Business Practice Location Address
First Line	:	3511 ETON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-6800
Country	:	US
Telephone Number	:	301-442-8846
Fax Number	:	301-442-8846

Authorized Official
Title or Position	:	DNP
Name	:	OKECHUKWU CYRIL AKUNWAFOR
Credential	:
Telephone Number	:	301-442-8846

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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